Sunday, May 29, 2011

Mother has second childhood when she wakes with Hollywood amnesia

When Su Meck was knocked out by a falling ceiling fan, she woke up a week later with a total memory loss.

She was 22 and bringing up two young sons in Gaithersburg, Maryland - but had the brain of a four-year-old when she regained consciousness in hospital and had to relearn everything, including how to dress herself and feed herself and even how to love her husband.

A scan of her brain showed it was full of cracks and her husband described it as 'like shaken jelly'.

The injury left her with complete retrograde amnesia, the inability to remember the past, a condition sometimes called Hollywood amnesia because it seldom happens outside the movies.

In fact, though extremely rare in real life, it is surprisingly common in the film world.

By 1926, at least 10 silent films that used amnesia as a plot device had been made; more recent productions include the Bourne franchise, First 50 Dates and Eternal Sunshine Of The Spotless Mind.

The condition causes the loss of memories to conscious recollection, beyond normal forgetfulness.

The person may be able to memorise new things but is unable to recall some or all of their life or identity prior to the onset.

Mrs Meck's case was extreme. She didn't recognise her husband or her children, she couldn't read or do very much for herself and she could speak only a few words and phrases.

But she had two babies to look after, so she had to start learning everything again - and fast, website Gizmodo reports.

Wednesday, May 25, 2011

A soldier's war on two fronts

The first time I met Spc. Shane Parham, his face was wrinkled with sadness. Beads of sweat met Iraqi dust and curved down his sunburned skin like the swampy Alcovy River in his native Georgia.

He was in the checkout line at Baghdad's Camp Striker commissary, only two months into his Iraq tour. But already, he'd witnessed war's brutality.

I thought of that first meeting recently as I peered at Parham through a 2-inch thick slab of glass in a prison visitation booth. The cinder-block walls, drab like the Iraqi desert, closed in on him.

Gone was his Army uniform. Instead, he wore tan prison garb, his hands bound in cuffs. His nails were long, his beard scraggly. He was not allowed to trim or shave for fear he might turn sharp instruments against himself, though he had once been chosen to man an M203 grenade launcher.

Tears trickled out of his tired blue eyes, no longer bright and full of promise.

He was a hero, honored by the governor of Georgia. Now the former sheriff's deputy was sharing quarters with thieves, addicts, even murderers.

I'd met him in July 2005, in the midst of a raging insurgency in Iraq. He was a soldier's soldier, used to carrying loaded guns and wearing bulletproof vests. Brawny. Proud. Someone who hunted the game and fowl he put on the Sunday table.

He'd arrived in Iraq ready to fight, heady with adrenaline. But now, four of his friends were dead.

I'd met him in July 2005, in the midst of a raging insurgency in Iraq. He was a soldier's soldier, used to carrying loaded guns and wearing bulletproof vests. Brawny. Proud. Someone who hunted the game and fowl he put on the Sunday table.

He'd arrived in Iraq ready to fight, heady with adrenaline. But now, four of his friends were dead.

At first, he couldn't even talk about what had happened. But in time, he would unload his tale of loss, sitting in a tent with head in hands, struggling for words to describe the unspeakable.

I knew it would be a long time before he healed. But neither of us could have predicted he would end up behind bars.

His yearlong tour cut short by injury, Parham only served seven months in Iraq. But, as he learned, it's not the length of time at war that can change a man, but what he experiences.

He came back to tiny Social Circle, Georgia, and tried to restart life, like the 2.2 million others who've returned from Iraq and Afghanistan. Of those, 43,000 came home without limbs or with other physical wounds, according to icasualties.org, which tracks combat deaths and injuries. One in five struggles on the inside.

They come back scarred by hidden wounds, such as post-traumatic stress disorder and traumatic brain injury. They fight the war on a second front, in the cities and homes of America.

A Department of Defense task force last year acknowledged the enormous physical and psychological demands placed on service members in two of America's longest-running wars. The group reported that more than 1,100 members of the armed forces took their own lives between 2005 and 2009, though it's not clear how many had been deployed. But the number represents an average of one suicide every 36 hours.

There are no definitive statistics on how many soldiers wind up in court because of their troubles. But the anecdotal evidence is strong: From New York to California, from Colorado to Georgia, veterans of Afghanistan and Iraq have been charged with crimes as serious as murder.

Sunday, May 22, 2011

Brain-injured ringleader gets four years in prison

How do we feel about this? How much responsibility should be placed on the shoulders of brain-injured defendants? Is it right to send persons with I.Q.s of 70 +/- to prison? If not, what should we do when they commit crimes? Do you think our criminal justice system is ass-backwards when it comes to sentencing the brain-injured and the mentally ill? And, perhaps most important of all, do you see a realistic chance of changing the way we deal with mentally ill and/orbrain-injured defendants in the near future?From TwinCities.com:

There were no winners in the courtroom when Anthony Martin Ramos was sentenced Friday to four years in prison for robbing and terrorizing a 16-year-old autistic boy in St. Paul.

Ramos, 25, sobbed as he apologized to the boy and his family, but he begged for help - instead of prison - for himself.

"I didn't want to hurt anybody," said Ramos, who suffered a traumatic brain injury at age 13 when an adult gave him methamphetamine and he overdosed.

His attorney, Marcus Almon, asked the judge for probation instead of prison time.

Ramos was the "ringleader" of five people, including two juveniles, who attacked the boy Dec. 23. They stalked him at a Cub Foods store in Sun Ray Shopping Center. One person asked him if he wanted to "hang out," and the group lured him to a deserted space near Conway Recreation Center.

Once there, they pushed him into the snow, handcuffed him, beat him, robbed him and shot him in the face with a BB gun.

Ramsey County District Judge Salvador Rosas ordered him to serve four years in prison, saying, "I wish there was a place I could send you that would keep you safe, that would keep our community safe, and that would help you."

In a written motion to the court, Almon said Ramos has an IQ of 74, cannot care for himself and has been in and out of treatment facilities since he suffered the brain injury.

He was civilly committed and lived in a foster home that specialized in patients with traumatic brain injuries until August 2010.

The commitment period ended. The attack on the autistic boy happened just a few months later.

Almon said he respected the judge's decision.

"Unfortunately, we had a case of the mentally ill versus the mentally ill," Almon said. "Until we figure this out, we're just going to be warehousing people with mental illness in prisons."

Friday, May 20, 2011

Cell Replacement Therapy: A Promising but Unproven Approach to Repairing the Parkinson’s Brain

Jack has long been a proponent of stem cell research, and especially embryonic stem cells, whose use has been controversial, with most opposition coming from a moral and/or religious based belief about the beginning of human life. Most opponents to embryonic stem cell research believe human life begins at conception, thus, in their view, it is morally wrong to use embryos for medical research, even though such embryos are often slated for destruction. Whatever one's stance on embryonic stem cells, many scientists believe they offer significant hope for curing many of our most devastating diseases. One example is Parkinson's Disease.

From The Michael J Fox Foundation: Cell replacement therapy seeks to restore function in the body by replacing cells lost due to disease with new, healthy ones. In Parkinson's disease, this means replacing dopamine cells in the brain, the main type of cell that degenerates in the disease. Researchers hope that one day they will be able to use stem cells or iPS cells to successfully engineer healthy new dopamine-producing cells. These healthy cells would then be implanted into the brain, where the cells could in theory restart the brain's production of dopamine and restore normal movement.

At this time scientists are working to overcome two major challenges: first, engineering the dopamine-producing cells (see Stem Cells 101); second, getting these cells to function properly once they are transplanted into the brain. To date, scientists have had the most success generating robust dopamine neurons, in both quantity and quality, using embryonic stem (ES) cells. However, whether these engineered dopamine neurons are sufficiently 'authentic' — that is, whether they express everything natural ones do — is a remaining challenge.

Even if seemingly authentic dopamine neurons can be generated, researchers face an enormous hurdle in coaxing these cells to grow and make the correct connections in a host brain. This involves determining where to place the cell grafts and how to deliver them without causing additional brain damage or triggering immune rejection or inflammatory effects.

Additionally, the new cells must also be able to retain the characteristics of a dopamine neuron once implanted in the brain, where they will be exposed to other factors that may influence their further development and survival. Following transplantation into pre-clinical models, today's engineered cells often do not survive for long, can turn into different cell types or in some cases cause uncontrolled cell growth. For this reason, they are obviously not yet ready for therapeutic use in humans.

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Based on evidence to date, the Foundation believes that the development of viable and feasible cell replacement therapies could revolutionize the treatment of Parkinson's disease. However, the hurdles to success are great; much work remains to be done before cell replacement therapy for PD is a viable therapy for patients. Furthermore, even if all roadblocks are overcome, cell replacement therapy may not be the “silver bullet” for treating PD. For example, researchers feel that dopamine cell replacement might have little or no effect on symptoms of PD not directly related to loss of dopamine cells, such as cognitive dysfunction, sleep problems, depression, constipation and gait and posture problems.

Convicted murderer seeks reduced sentence due to brain injury

An attorney for a convicted murderer argued in court Monday that his client suffers from diminished capacity to “appreciate the wrongfulness of his conduct” due to a traumatic brain injury and is entitled to an exceptional sentence that could shave five years off his prison term.

Michael Kerby, 50, pleaded guilty to second-degree murder in February in connection with Gerald Haag’s strangulation death in January 2010 in Haag’s home off 101st Avenue Southwest, south of Tumwater.

Kerby’s attorney, Larry Jefferson, has asked the court to give Kerby a 10-year prison sentence – five years less than what is being asked for by the prosecution.

Jefferson argues in court documents that because of a brain injury Kerby suffered in a 2006 motorcycle accident, his “capacity to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of law was significantly impaired.”

Expert witnesses testified on behalf of the prosecution and defense during Monday’s hearing. The hearing will continue at 1:30 p.m. today.

A defense expert wrote a report indicating that Kerby had suffered “a severe head injury with ‘bilateral frontal lobe contusions’” and that he “bruised the part of his brain responsible for thinking, reasoning and problem-solving,” court papers state.

“It has been established that Mr. Kerby was a law-abiding individual that supported himself and his family before his brain injury,” Jefferson wrote. “After his motorcycle accident he lost everything. He went from being a law-abiding person to a homeless veteran, brain-damaged and with no family support.”

Monday, May 16, 2011

New Research Shows Promise for TBI Treatment

From NewsWise: In a collaborative program with the Uniformed Services University of the Health Sciences (USU) under the leadership of Dr. Daniel Perl, professor of Pathology, USU, Dr. Stanley Prusiner and the Institute for Neurodegenerative Diseases (IND) at University of California at San Francisco (UCSF), has made an encouraging start to identify drugs to treat troops suffering from the long-term effects of traumatic brain injury (TBI).

They are identifying drugs that can reduce the accumulation of proteins in the brain that are a result of traumatic brain injury and thus halt the progression of the injury. It is the focal accumulation of an abnormal form of the tau protein, particularly in the frontal lobes, that causes central nervous system dysfunction. This is similar to what has been recently described in the National Football League (NFL). Currently there are no drugs available to stop, or even slow, tau production or aggregation. The identification of such drugs is an urgent medical and societal issue.

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The Uniformed Services University of the Health Sciences, or USU, is the nation’s federal health sciences university. USU students are primarily active-duty uniformed officers in the Army, Navy, Air Force and Public Health Service who are being educated to deal with wartime casualties, emerging infectious diseases and other public health emergencies. Of the university’s more than 4,500 physician alumni, the vast majority are supporting operations in Iraq, Afghanistan and elsewhere, offering their leadership and expertise. For more information, visit www.usuhs.mil.

Sunday, May 15, 2011

Understanding Parkinson’s Disease

Since Jack was diagnosed with Parkinson's Disease, we've added that to topics that we blog about here on the TBI Blog. For new readers who might not be familiar with Parkinson's, here is a brief intro to the disease:

From HealBlog.net: Parkinson’s disease is one of the most common degenerative brain disorders today. It was previously called as “shaky palsy” when Dr. James Parkinson identified the disease in 1817. It was called as “shaky palsy” because of the characteristic sign of shakiness among people suffering from the said disease.

Parkinson’s disease occurs when the brain cells progressively injures and degenerates. When this happens, our brain cells die and lose function. The exact cause of this disease in unknown however, many scientists point out to its connection to genetics and environmental factors.

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Difficulty moving and loss of movement coordination is a common symptom Parkinson’s Disease. This is due to the loss of Dopamine which is responsible for many of our gross and fine motor skills. This is most evident when a person walks in a shuffling gait.

Shakiness and tremors are also common symptoms of PD. This is the most common early sign of PD and may occur initially in the fingers, hands, arms and may progress to the face, jaw and legs.

Muscle stiffness is also one of the cardinal signs of PD which may leave a patient with PD unable to move his or her arms and legs altogether.

Thursday, May 12, 2011

Traumatic Brain Injury Rehab Bill Offers Warriors New Hope

Wounded Warrior Project applauds Senator John Boozman (R-AR) with lead co-sponsor, Mark Begich (D-AK) and Congressman Tim Walz (D-MN/1) with lead co-sponsor Gus Bilirakis (R-FL/9) for introducing companion legislation in the House and Senate today that would ensure fuller lives for warriors who sustained severe traumatic brain injuries (TBI) in Iraq and Afghanistan, and urges speedy action on this measure.

The Veterans’ Traumatic Brain Injury Rehabilitative Services’ Improvement Act of 2011 would require VA to provide veterans who have severe TBI with ongoing, long-term rehabilitative care, including support services to maximize independence and quality of life.

“This important bipartisan, bi-cameral legislation would close critical gaps in VA rehabilitation programs for warriors who have suffered severe traumatic brain injury,” said Steve Nardizzi, Executive Director, Wounded Warrior Project. “These complex injuries often require long-term rehabilitative care. The legislation would help ensure that needed rehabilitation is not prematurely cut off, and that these veterans can get the supports they need -- whether those are health-services or non-medical assistance -- to achieve maximum independence and quality of life.”

Traumatic brain injury represents one of the most complex and potentially severe injuries incurred by service members deployed in Operation Enduring Freedom and Operation Iraqi Freedom. While symptoms from a mild or moderate TBI are more likely to dissipate, severe TBI can result in lasting and persistent neurological and cognitive deficits.

Tuesday, May 10, 2011

According to a recent study, traumatic brain injury among children is uncommon, yet nearly half of U.S. children taken to hospital emergency departments (ED) for head injuries receive a CT scan, Medical Xpress reports.

The study revealed that a CT scan is not necessary but is mostly used to ease parents’ concerns. According to Medical Xpress, Lise Nigrovic, MD, MPH, of Children's Hospital Boston and co-author of the study, said in a statement, “Only a small percentage of children with blunt head trauma really have something serious going on. If you can be watched in the ED for a few hours, you may not need a CT."

The study, led by Children's Hospital Boston and UC Davis, consisted of more than 40,000 children with only minor blunt head trauma. Findings from the study showed that allowing a period of observation can reduce the use of CT scans by about 50 percent and prevent exposure to ionizing radiation.

Researchers say the change in procedure would be cost-effective as well.

There's no preparation for joining the ranks of "Young Parkies," as some call those diagnosed with the disease at the peak of career and family responsibilities. But awareness is growing that Parkinson's can emerge in your 30s, 40s or 50s — as it did for actor Michael J. Fox and as many as 300,000 Americans who have been diagnosed with early onset Parkinson's.

While the classic tremors, stiffness and slowness are devastating at any age, the symptoms become all the more challenging when juggled with full-time jobs and young children. Do you tell your boss, or hide your shaking by burying your hand in your pocket? How do you plan your life around a degenerative disease with no cure? Current therapies only relieve symptoms for a limited time; they do not slow the neurological deterioration.

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Parkinson's patients don't have enough of a substance called dopamine — the chemical messenger that transmits the signals from the brain that coordinate movement.

Not all patients have the trademark tremors. Many find their muscles become extraordinarily stiff, tight and cramp uncontrollably. Movement slows down, whether walking, forming a fist or even blinking.

No one knows exactly what causes the disease, but both genetic and environmental factors are thought to be at play. People with an immediate family member with Parkinson's are about three times more likely to develop it than those with no family history.

Friday, May 06, 2011

Happy Birthday, Michael J. Fox

The current issue of Good Housekeeping has an interview with Michael J. Fox, who announced publicly in 1998 that he has Parkinson's Disease. Since that time, the Michael J. Fox Foundation has funded more than $238 million in research, either directly or through partnerships. The foundation "is dedicated to finding a cure for Parkinson’s disease through an aggressively funded research agenda and to ensuring the development of improved therapies for those living with Parkinson’s today."

Here's an excerpt from the interview, prompted by Fox's approaching 50th birthday:

RE: Right. Which is something you must have thought about a lot when you were first diagnosed. Things like that — big life-changers and significant birthdays — make you reconsider what you value.

MJF: You know, there's a rule in acting called "Don't play the result." If you have a character who's going to end up in a certain place, don't play that until you get there. Play each scene and each beat as it comes. And that's what you do in your life: You don't play the result.

So you get diagnosed with Parkinson's, and you can play the result. You can go right to, "Oh, I'm sick." It took me seven years to figure out that I'm not at the result. I'm not at the result till the end. So let's not play it. It's not written yet. And so that's the attitude I take in life. Another expression is "Act as if." Act as if it's the way you want it to be, and it'll eventually morph into that.

RE: That's a very wise attitude.

MJF: Well, with Parkinson's, it's like you're in the middle of the street and you're stuck there in cement shoes and you know a bus is coming at you, but you don't know when. You think you can hear it rumbling, but you have a lot of time to think. And so you just don't live that moment of the bus hitting you until it happens. There's all kinds of room in that space.

RE: What's the hardest part about Parkinson's?

MJF: I actually never talk about this, but the hardest thing is probably the fatigue. And trying to have a higher threshold for it. Sometimes there may be things I want to do, and I say, "I'm so freakin' tired. I don't know if I can do it." And then I'll do it and I'll never regret that I did it. But [the hardest part is] just getting over that.

Wednesday, May 04, 2011

Concussions Impact US Teen Athletes: Brain injuries represent 10 percent of all high school athletic injuries

There are an estimated 300,000 sports-related traumatic brain injuries in the United States each year.

A national study by a major pediatric research center of young athletes 15-to-24 years old reveals that sports are second only to motor vehicle crashes as the leading cause of injury to the brain.

And concussions represent 10 percent of all high school athletic injuries.

Every year, more than 60,000 U.S. high school athletes sustain a concussion, a type of brain injury that can be caused by a blow to the head or even the upper body. While most of them occur during a game or practice of American football, concussions can also happen in just about any other contact sport. This includes soccer, lacrosse, baseball and even wrestling.

Certified athletic trainer Alison Lane of Annandale High School in Virginia says:

"We do a pre-screening where we do a baseline cognitive test where we have the athletes sit down and take a 20-minute test to see how they think cognitively when they’re healthy, so that when they do get injured and they do sustain a concussion, we can then go back and compare it. That gives us some objective data to use when we’re evaluating and deciding whether an athlete is ready to go back to play."

If you've read this blog for any length of time, you might remember that Jack funded Alexandria Virginia's Episcopal High School's baseline cognitive tests years ago, when no one was doing them. Jack's foresight was right on as today more and more schools and even school districts are requiring baselines for all athletes in contact sports. Long overdue, but still very welcome.

Monday, May 02, 2011

Exploring group checkups for diabetes, Parkinson's

Group appointments aren't just for psychotherapy anymore. Put diabetes, high blood pressure and maybe even Parkinson's disease on the list.

Shared checkups aim to help patients who are battling certain chronic diseases, and they're far from the typical 15-minute office visit. They're stretched over 90 minutes or even two hours, offering more time to quiz the doctor about concerns, learn about managing the disease — and get tips from fellow patients.

What's in it for the doctor? A neurologist found he learned more about how his Parkinson's patients were faring by watching them interact with others than when he had them one-on-one.

"I can see if you're getting worse over the course of the visit, your ability to eat, to walk, to converse and to think," says Dr. Ray Dorsey, who led a pilot study of group checkups for Parkinson's patients at the University of Rochester Medical Center.

"This is a new way of delivering health care," adds Dorsey, now at Johns Hopkins University. "People are thirsting for better ways."

It's a small but slowly growing trend that promises to get more attention with the tight supply of primary care physicians, who find it hard to squeeze in time to teach their patients how to deal with complex chronic illnesses like diabetes. An American Academy of Family Physicians survey found more doctors trying the group approach — about 10 percent of its active members in 2009, up from fewer than 6 percent in 2005.

Peer pressure among patients helps, says family physician Dr. George Whiddon of Quincy, Fla. He has about 40 diabetic patients divided into groups for shared checkups at Tallahassee Memorial Family Medicine Quincy, and he wants to add more.

One woman with uncontrolled diabetes for years confessed to fellow patients that she'd ignored Whiddon's "eat better, take your meds" advice for too long.

"Now I only have one toe left. I should have listened," Whiddon recalls her saying. "That had more impact than anything I said all day."